1568796027 NPI number — COMMUNITY ACTION OF SOUTHEASTERN WEST VIRGINIA

Table of content: (NPI 1568796027)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1568796027 NPI number — COMMUNITY ACTION OF SOUTHEASTERN WEST VIRGINIA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COMMUNITY ACTION OF SOUTHEASTERN WEST VIRGINIA
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
CASE WV COMMISSION ON AGING
Provider Other Organization Name Type Code:
5
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1568796027
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
307 FEDERAL ST
Provider Second Line Business Mailing Address:
SUITE 323
Provider Business Mailing Address City Name:
BLUEFIELD
Provider Business Mailing Address State Name:
WV
Provider Business Mailing Address Postal Code:
24701-3063
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
304-327-3506
Provider Business Mailing Address Fax Number:
304-327-8822

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
355 BLUEFIELD AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BLUEFIELD
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
24701-2883
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-327-3506
Provider Business Practice Location Address Fax Number:
304-327-8822
Provider Enumeration Date:
09/30/2009

Additional Information

Authorized Official

Authorized Official Last Name:
HUBBARD
Authorized Official First Name:
ORAETTA
Authorized Official Middle Name:
K.
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
304-327-3501

Provider Taxonomy Codes

  • Taxonomy code: 253Z00000X , with the licence number:  001 , registered in the state of WV ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2024 www.npivalidator.com